Deck 53: Neonatal and Pediatric Respiratory Care

Question 1

Tachypnea in the newborn is defined as a respiratory rate greater than what level?

A) 40/min
B) 50/min
C) 60/min
D) 70/min

Answer 1

C
Explanation: Infant physical assessment begins with measurement of vital signs. A normal newborn respiratory rate is 40 to 60/min.

Question 2

Temporary drops in the fetal heart rate during uterine contractions are known as:

A) fetal stress.
B) decelerations.
C) primary apnea.
D) secondary bradycardia.

Answer 2

B
Explanation: Temporary drops in fetal heart rate are called decelerations and can be mild (<15 beats/min), moderate (15 to 45 beats/min), or severe (>45 beats/min). Decelerations are classified by their occurrence in the uterine contraction cycle.

Question 3

Late decelerations are consistent with which of the following conditions?
1) Uteroplacental insufficiency
2) Umbilical cord compression
3) Normal contraction
4) Maternal bradycardia

A)1 and 2 only
B)2 and 3 only
C)3 and 4 only
D)1, 2, 3, and 4

Answer 3

A

Question 4

You notice in drawing (retractions) of chest-wall muscle and tissue between the ribs, and above and below the sternum, all occurring during inspiration. Which of the following conclusions is most consistent with this observation?

A) Airway resistance (Raw) is decreased.
B) Lung compliance (C_L) is decreased.
C) Work of breathing is decreased.
D) Chest-wall compliance is decreased.

Question 5

Which of the following L:S ratios indicates stable surfactant production and mature lungs?

A) 2:1
B) 1:1
C) 1:2
D) 2:3

Question 6

You notice in the chart of an infant receiving neonatal intensive care the designation "preterm, AGA." Based on this information, what can you correctly conclude?

A) This is an infant whose weight falls between the tenth and ninetieth percentiles.
B) This is an infant whose weight falls between the tenth and fiftieth percentiles.
C) This is an infant whose weight falls between the fiftieth and ninetieth percentiles.
D) This is an infant whose weight falls between the tenth and twentieth percentiles.

Question 7

You detect a "bounding" peripheral pulse on a newborn infant. Based on this finding, what should you suspect?

A) Patent ductus arteriosus
B) Peripheral vasoconstriction
C) Coarctation of the aorta
D) Peripheral vasodilation

Question 8

Which of the following maternal factors is/are related to the health of the fetus and the outcomes of pregnancy?
1) Maternal age
2) Prior maternal disease
3) Maternal drug use
4) Maternal birth history

A)1, 2, and 3 only
B)2 and 4 only
C)1, 2, 3, and 4
D)3 and 4 only

Question 9

At 1 min after birth, a newborn infant exhibits the following: heart rate of 65/min, a slow and irregular respiratory rate, some muscle flexion, a grimace when nasally suctioned, and a pink body with blue extremities. What is the infant's 1-min Apgar score?

A) 3
B) 4
C) 5
D) 6

Question 10

Which of the following vacuum settings would you use to perform nasopharyngeal or nasotracheal suctioning of a 5-year-old child?

A) -100 to -120 mm Hg
B) -80 to -100 mm Hg
C) -40 to -60 mm Hg
D) -60 to -80 mm Hg

Question 11

Which of the following sizes (internal diameter) of endotracheal tubes would you select to intubate a 4-year-old child?

A) 3 mm
B) 4 mm
C) 5 mm
D) 7 mm

Question 12

You notice paradoxical breathing. Which of the following conclusions is most consistent with this observation?

A) Airway resistance (Raw) is decreased.
B) Lung compliance (C_L) is increased.
C) Work of breathing is increased.
D) Chest-wall compliance is decreased.

Question 13

The most probable explanation for the flip-flop phenomenon in the newborn is:

A) oxygen (O₂) toxicity.
B) right-to-left shunting.
C) cardiac disease.
D) reactive pulmonary vasoconstriction.

Question 14

Which of the following techniques would you recommend to assess the state of pulmonary maturity before birth?

A) Blood gas analysis
B) Ultrasonography
C) Maternal history
D) Amniocentesis

Question 15

Which of the following methods is useful in determining gestational age of the newborn?

A) Dubowitz
B) Adams
C) Apgar
D) Perkinson

Question 16

What is the normal arterial PO₂ in healthy infants?

A) Greater than 50 mm Hg
B) Greater than 60 mm Hg
C) Greater than 70 mm Hg
D) Greater than 80 mm Hg

Question 17

Which of the following pH values is associated with fetal asphyxia?

A) Less than 7.1
B) Less than 7.2
C) Less than 7.3
D) Less than 7.4

Question 18

What FiO₂ should be used in neonates prior to endotracheal suctioning?

A) Same FiO₂ on the ventilator
B) Always 100%
C) FiO₂ 10% to 15% higher than FiO₂ set in the ventilator
D) Low FiO₂ to prevent retinopathy of prematurity

Question 19

In which of the following conditions may bronchial hygiene therapy be considered for infants or children?
1) Hyaline membrane disease
2) Foreign body aspiration
3) Cystic fibrosis
4) Bronchopulmonary dysplasia (BPD)

A)2 and 4 only
B)1, 3, and 4 only
C)2, 3, and 4 only
D)1, 2, 3, and 4

Question 20

Which of the following O₂ modalities would you recommend for a toddler needing a low FiO₂?

A) Mist tent
B) Cannula
C) Oxy-Hood
D) Mask

Question 21

Which of the following is considered a limitation of the high-flow nasal cannula?

A) It does not meet patient's flow needs.
B) The amount of airway positive pressure cannot be measured.
C) It does not provide for appropriate CO₂ clearance.
D) It does not reduce the use of noninvasive positive-pressure ventilation.

Question 22

Which of the following tidal volume range would you recommend for an infant with severe ARDS?

A) 3 to 4 ml/kg
B) 4 to 5 ml/kg
C) 6 to 7 ml/kg
D) Greater than 8 ml/kg

Question 23

What V_T range should be used for mechanical ventilation of a neonate?

A) 5 to 7 ml/kg
B) 6 to 8 ml/kg
C) 8 to 10 ml/kg
D) 10 to 12 ml/kg

Question 24

What positive end expiratory pressure level is commonly used in pediatric patients during mechanical ventilation?

A) 1 to 3 cm H₂O
B) 3 to 5 cm H₂O
C) 5 to 8 cm H₂O
D) 10 to 12 cm H₂O

Question 25

What initial inspiratory time range would you suggest for a term newborn infant being placed on time-cycled, pressure-limited ventilation?

A) 0.20 to 0.40 sec
B) 0.30 to 0.50 sec
C) 0.50 to 0.70 sec
D) 0.70 to 1.00 sec

Question 26

Which of the following may indicate a decrease in systemic vascular blood flow during high-frequency ventilation?
1) High central venous pressure (CVP)
2) Low CVP
3) Decreased mean arterial pressure (MAP)
4) Increased MAP

A)1 and 3 only
B)2 and 3 only
C)1 and 4 only
D)1, 2, 3, and 4

Question 27

In high-frequency ventilation (HFV), CO₂ elimination depends mainly on which of the following?

A) Pressure amplitude
B) Mean airway pressure
C) High-frequency rate
D) Sinusoidal waveform

Question 28

Signs of infant respiratory distress that indicate a potential need for continuous positive airway pressure (CPAP) include which of the following?
1) Cyanosis
2) Radiograph indicating hyaline membrane disease or respiratory distress syndrome
3) Grunting
4) Severe retractions

A)3 and 4 only
B)1, 2, and 3 only
C)2 and 4 only
D)1, 2, 3, and 4

Question 29

During resuscitation of a newborn, after 15 to 30 sec of positive-pressure ventilation, what should the clinician do?

A) Evaluate the heart rate.
B) Suction the mouth, then the nose.
C) Begin chest compressions.
D) Initiate medications.

Question 30

Which of the following conditions affect placental blood flow during pregnancy?
1) Previous miscarriage
2) Smoking abstinence
3) Previous pregnancy complications
4) History of diabetes

A)1 and 3 only
B)1, 2, and 3 only
C)3 and 4 only
D)1, 3, and 4 only

Question 31

Which of the following mean airway pressures is considered potentially deleterious when applying positive end expiratory pressure?

A) 2 cm H₂O
B) 5 cm H₂O
C) 10 cm H₂O
D) 15 cm H₂O

Question 32

You are called to the NICU to assess the blood pressure of a neonate who weighs 750

A) 40/25
B) 45/35
C) 55/40
D) 55/25
G) You determine that the pressure is normal. Which of the following pressure did you obtain?

Question 33

What is the recommended dose of inhaled NO?

A) 10 ppm
B) 20 ppm
C) 30 ppm
D) 40 ppm

Question 34

What physiologic effect does inhaled nitric oxide have on the lung?

A) Pulmonary vasoconstriction
B) Pulmonary vasodilation
C) Smooth muscle dilation
D) Improved mucociliary clearance